title: Ophthalmic surgery simulator training improves resident performance of capsulorhexis in the operating room.
abstract: OBJECTIVE
  To assess the effect of a Capsulorhexis Intensive Training Curriculum (CITC) on the rates of errant, continuous, curvilinear capsulorhexes (CCCs) during cataract surgery among resident surgeons at a teaching hospital.
  
  
  METHODS
  Retrospective educational interventional case series.
  
  
  METHODS
  A total of 1037 consecutive cataract surgeries performed at Harbor-UCLA Medical Center during 4 consecutive academic years were considered. The baseline cohort consists of 434 cataract surgeries performed during the 2 academic years before the intervention. The postintervention cohort consists of 603 cataract surgeries performed during the following 2 consecutive academic years.
  
  
  METHODS
  The principal intervention was the introduction of the CITC for residents on the Eyesi (VRmagic, Mannheim, Germany) ophthalmic virtual reality surgical simulator.
  
  
  METHODS
  The main outcome measure was the rate of errant CCCs among the capsulorhexes performed during resident surgical cases. Errant CCCs were defined as attempted CCCs that resulted in the attending physician taking over, radialization of the CCC, conversion to can-opener capsulorhexis, or any combination of the 3 aforementioned conditions. Secondary measures included the use of trypan blue during CCC and correlating errant CCC and surgeons' level of training (postgraduate year [PGY]).
  
  
  RESULTS
  There were 68 errant CCCs (15.7%) in the baseline cohort and 30 errant CCCs (5.0%; P<0.0001) in the postintervention cohort, a 3.2-fold or 68% reduction. The use of trypan blue increased from 55.3% in the baseline cohort to 76.0% in the postintervention cohort (P<0.00001), but within each cohort there was no significant difference in the rate of errant CCCs whether trypan blue was used or not. In the baseline cohort, there was a statistical trend toward fewer errant CCCs among PGY 4 (14.6%) compared with PGY 3 (22.8%) surgeons (P = 0.12). The postintervention cohort showed no significant difference in errant CCC rates between PGY 3 (4.4%) and PGY 4 (5.1%) surgeons (P = 1.00).
  
  
  CONCLUSIONS
  This study strongly suggests that virtual reality surgical simulation training with the CITC on the Eyesi reduces the rate of errant capsulorhexes. The incorporation of a formal program for surgical training via virtual reality simulation should be strongly considered in ophthalmology resident surgical education to reduce the unnecessary risk of complications for live patients.
authors.affiliation: Jules Stein Eye Institute, Los Angeles, California; Harbor-UCLA Medical Center, Torrance, California. Electronic address: cmccannel@jsei.ucla.edu.
authors.forename: Colin A
authors.initials: CA
authors.lastname: McCannel
authors.affiliation: Jules Stein Eye Institute, Los Angeles, California.
authors.forename: David C
authors.initials: DC
authors.lastname: Reed
authors.affiliation: Jules Stein Eye Institute, Los Angeles, California.
authors.forename: Darin R
authors.initials: DR
authors.lastname: Goldman
mesh_terms: D019923:Capsulorhexis / Q000193:education*; D002983:Clinical Competence; D004396:Coloring Agents; D003198:Computer Simulation; D003479:Curriculum; D004503:Education, Medical, Graduate; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D009885:Ophthalmology / Q000193:education*; D018918:Phacoemulsification / Q000193:education; D012189:Retrospective Studies; D013647:Task Performance and Analysis; D014343:Trypan Blue
chemical_list: D004396:Coloring Agents; D014343:Trypan Blue